Oregon is a state that hasn’t created a single statewide health information exchange, but Medford, Ore.-based Reliance eHealth Collaborative has been gradually growing into all the rural areas of the state and is starting to make inroads in the Portland metro area, as well as Northern California and Washington state.
In a recent interview, Erick Maddox, executive director of Medford, Ore.-based Reliance eHealth Collaborative, said the shift to value-based care is part of the reason for its growth.
Founded about 10 years ago, Reliance is a community HIE and doesn’t get state or federal funding. “We were truly established by the healthcare community initially in Medford and Southern Oregon, and we have grown organically across the state and now actually have a tiny footprint in Northern California and have a growing catchment area and growing participation base in the State of Washington,” he said.
Although Reliance traditionally hasn’t had many Portland-area members, that is changing, Maddox says. “We were founded in rural Oregon, and have historically had our strongest and deepest participation in rural Oregon. That is changing drastically as providers and networks in Oregon start to adopt value-based purchasing agreements, setting up risk-sharing, cost-sharing agreements in healthcare,” Maddox said. “They're finding the need for more robust data. The Portland metro area is very competitive in healthcare even though they're all not-for-profit. Whenever it comes to data sharing, they each have their own paths. But now they're finding that doesn't work. So we're seeing massive change in the Portland metro area. We have some significant adoption taking place right now.”
I asked Maddox if the lack of interest in building a Portland-area HIE previously was because almost all the large health systems there use Epic’s EHR and figure they will just use its Care Everywhere to exchange data among themselves.
“I think there are two parts to that,” he said. “Certainly, Epic is a component to it. There are holdouts who say we have everything we need in Epic. But what we have seen over time is that when we get out into the smaller doctor's offices, when we get into the rural communities, Epic is not present,” Maddox added. “What the health systems and Epic users are finally realizing is that it doesn't give them everything, it doesn't do all of the things that they need to do. Or they have to invest a lot of money and time and writing special reports and setting up special configurations in order to make Epic do all of these wonderful things. In reality, it's cheaper, more effective and more efficient to work with our local health information exchange. So that realization is taking place in the metro area. It is a realization that has been in place for our Epic users in the rural portions of Oregon for some time, but they are coming to that realization in the metro area.”
The other key piece is the CCO [coordinated care organization] initiative in Oregon. “All the systems and the doctors’ offices and providers in the metro area, of course, and this goes even in the rural portions of the state, they follow the CCOs,” Maddox said. “They're going to do what they need to do to be in line with those CCOs. Also, Medicare Advantage plans are pushing networks to the HIE, because the Medicare Advantage plans have realized we can do data acquisition, we can get our HEDIS data, we can get these metrics that we need from the HIE much more cost-effectively, than we can by going to each network and asking for access to Epic.”
In some states, a combination of carrots and sticks is usually deployed to get healthcare providers to get involved in HIE or other health IT projects. But Maddox says Reliance’s philosophy is that they don't tend to like state mandates. “We truly want community adoption. We don't want it to be a forced function that says we have to do it,” he explained. “In fact, if there is a perception that the state is behind it, we can have parts of the State of Oregon that just instantly go into opposition. So that has the potential to create a different kind of barrier for us. We have been successful as far as a community-based initiative. We are going to prove our value and we are going to see adoption based on the value and effectiveness of the HIE, not based on a state mandate or a payer mandate.”
Maddox said that some health IT projects that were originally fully subsidized by the state to get off the ground are in danger of faltering if the state tries to withdraw funding, so the Legislature has to find continued funding to keep them going. “I think the key for community information exchange or anything in this space that the state gets involved in is yes, come help fund it and help get it off the ground, and be a part of the conversation. But don't set it up in such a way that now we are dependent on you.”